Only 10% of U.S. Children Aged 6 Months–4 Years Had a COVID-19 Vaccine by End of 2022

Severe COVID-19 is more common in older adults, but young children are affected too. By December 2022, more than 3 million COVID-19 cases had been reported in children under 5, with more than 500 deaths since the pandemic began. One in four children hospitalized with COVID-19 needed intensive care, and 21.2% of MIS-C cases were in children aged 1–4, with 3.2% in infants.

On June 17, 2022, the FDA authorized the Moderna vaccine for children 6 months–5 years and Pfizer-BioNTech for 6 months–4 years. CDC used vaccine administration data from the 50 states and D.C. to measure coverage among children 6 months to 4 years from June 20 to December 31, 2022.

Key findings

By comparison, two months after vaccines were approved for older children, 24.0% of children aged 5–11 and 33.3% of those 12–15 had been vaccinated.

Children aged 6 months–4 years with at least one COVID-19 vaccine dose, by jurisdiction. From CDC's MMWR.

Gaps

Urban and rural: coverage was 10.5% in urban counties but 3.4% in rural ones, falling steadily from 12.5% in large metro areas to 2.7% in the most rural. Urban coverage was higher in 41 jurisdictions; Arizona and Wyoming were exceptions, with higher rural coverage, for reasons not well understood.

Race and ethnicity (known for 71.4% of vaccinated children):

Race and ethnicity of children with at least one dose, compared with all U.S. children aged 6 months–4 years. From CDC's MMWR.

Why

• Poverty is higher in Black (19.5%) and Hispanic (17.0%) communities than White (8.2%), which can limit access to vaccination sites, time off work and pediatric care.
• In a July 2022 Kaiser Family Foundation survey, 47% of parents with household incomes of $90,000 or more had talked with a pediatrician about the vaccine, versus 18% with incomes of $40,000–$90,000 and 28% under $40,000.
• About 40% of Hispanic parents said they couldn't get the vaccine somewhere they trust, and about a third worried about paying out of pocket (versus 13% of White parents). About 40% of Black parents worried about taking time off work for the shot or side effects (versus 18% of White parents).
• In a survey, 53% of rural parents said they would probably or definitely not vaccinate their child, versus 38% of suburban parents.
• Hesitancy: among parents of unvaccinated young children, about 80% worried about side effects and 70% that the vaccine wouldn't prevent illness; by September 2022, more than half said they would "definitely not" vaccinate.

What can help

A medical home and a recommendation from a trusted provider can address parents' concerns about safety and effectiveness. Public health workers, clinicians, child care and school leaders, and state and local governments can use evidence-based practices to lower barriers and build confidence. The low coverage is especially concerning now that bivalent booster doses are also authorized for this age group.

Limits: doses given by different providers may not have been linked, understating series completion; race and ethnicity were unknown for about 30%; "other" race is reported inconsistently; and the 2013 urban-rural categories may be out of date.

Sources

Based on Murthy BP, Fast HE, Zell E, et al., "COVID-19 Vaccination Coverage and Demographic Characteristics of Infants and Children Aged 6 Months–4 Years — United States, June 20–December 31, 2022," Morbidity and Mortality Weekly Report 72(7), CDC; a work of the United States government in the public domain.